| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY | 1750 E GOLF RD STE 1100 SCHAUMBURG, IL 60173 | BLUE CROSS BLUE SHIELD OF ILLINOIS | $63K | $4K | $66K | 4.01% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY LTD. | ONCE CENTURY CENTRE 1750 E GOLD RD, STE 1100 SCHAUMBURG, IL 60173 | DEARBORN NATIONAL LIFE INSURANCE COMPANY | $2K | — | $2K | 10.47% |
| ASSURANCE AGENCY LTD3 | 1750 EAST GOLF ROAD STE 1100 SCHAUMBURG, IL 60173 | PRINCIPAL LIFE INSURANCE COMPANY | $751 | $468 | $1K | 6.44% |
| ASSURANCE AGENCY LTD3 Filed as: ASSURANCE AGENCY, LTD. | 1750 E GOLF RD STE 140 CHICAGO, IL 60173 | VISION SERVICE PLAN | $1K | — | $1K | 5.85% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 148 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 152 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | BLUE CROSS BLUE SHIELD OF ILLINOIS | 275 | $1.6M |
| Dental | PRINCIPAL LIFE INSURANCE COMPANY | 355 | $19K |
| Vision | VISION SERVICE PLAN | 148 | $17K |
| Life insurance | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 144 | $23K |
| Short-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 144 | $23K |
| Long-term disability | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 144 | $23K |
| Other | DEARBORN NATIONAL LIFE INSURANCE COMPANY | 144 | $23K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 355 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.